Caren van Roekel

57 Radioembolization groups. Median time to progression was 6.4 months in the TACE group and not reached in the radioembolization group (p=0.002). However, this significantly longer time to progression did not translate into a significant difference in overall survival (116). Katsanos et al. have compared the effectiveness of different transarterial embolization therapies, alone or in combination with local ablative or adjuvant systemic treatments, in patients with HCC. They compared studies investigating bland transarterial embolization (TAE), TACE, chemoembolization with drug- eluting beads (DEB-TACE), TACE+radiotherapy, TACE+ablation, TACE+adjuvant, DEB-TACE+adjuvant and radioembolization with control series. TACE combined with external radiation therapy or percutaneous tumor ablation were found to be the most effective treatment strategies, in terms of overall survival. Radioembolization was proven to be the safest treatment modality with less adverse events and side effects than the other locoregional therapies. Median survival of patients treated with radioembolization was 24.3 months, compared to 13.9 months in the control series with best supportive treatment (117). In BCLC stage C patients, a portal vein tumor thrombus (PVT) is present, which is a contraindication for surgery and chemoembolization, but not for radioembolization. In a retrospective cohort study of 41 patients, Garin et al. showed that good PVT targeting and a tumor dose ≥205 Gy are significantly correlated with overall survival. Using aimed absorbed dose intensification, a high response rate of 85% was obtained (118). Ali et al. have studied factors influencing survival in BCLC stage C patients treated with radioembolization. Three-hundred forty-five patients were included, of whom 223 had a performance status of 1 and 10 an ECOG performance score of 2. Ninety-six patients had a portal vein tumor thrombus (PVT) before therapy and 16 patients had extrahepatic metastases. The median OS was 10.7 months. Multivariate survival analysis showed that median OS was significantly longer for patients without PVT than for patients with PVT: 15.6 versus 7.3 months, p<0.0001. Extrahepatic disease at baseline also significantly influenced median OS: 7.4 versus 12.6 months for patients with and without extrahepatic metastases (119). The presence of PVT as a prognostic factor is confirmed by Floridi et al. who studied radioembolization in patients with mainly BCLC stage B. These patients had a longer median OS of 22.7 months after radioembolization (120). 2